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IL RICONOSCIMENTO DEI DISTURBI EMOTIVI NELLA MEDICINA DI BASE:IL RUOLO DELLA COMUNICAZIONE MEDICO-PAZIENTE
Anna Saltini
Servizio di Psicologia Medica
Istituto di Psichiatria
Università di Verona - Ospedale Policlinico
INTRODUZIONE
L'INTERLOCUTORE DEL MEDICO DI BASE
L'APPROCCIO AL PAZIENTE E ALLA MALATTIA
L'INTERVISTA MEDICA
IL MEDICO DI BASE E L'IDENTIFICAZIONE DEI DISTURBI EMOTIVI: EVIDENZE DEL RUOLO DELL'INTERVISTA MEDICA
LA FORMAZIONE DEL MEDICO DI BASE. QUALI BENEFICI?
CONCLUSIONI
BIBLIOGRAFIA
Bibliografia
- ANDERSON SM, HARTHORN BH: Intervening in the diagnostic knowledge and treatment decisions of primary care physicians. Paper presented at The Fourth Annual NIMH Conference on the Classification and Treatment of Mental Disorders in General Medical Settings, Bethesda, MA, 1990.
- ASHWORTH CD, WILLIAMSON P, MONTANO D: A scale to measure physician beliefs about psychosocial aspects of patient care. J Sci Med 1984; 19, 1235-1238.
- BADGER LW, DeGRUY FV, HARTMAN J, PLANT MA, LEEPER I, FICKEN R, MAXWELL A, RAND E, ANDERSON R, TEMPLETON B: Psychosocial interest, medical interviews and the recognition of depression. Arch Fam Med 1994; 3, 899-907.
- BALINT M, HUNT J, JOYCE D et al: Treatment or diagnosis: a study of repeat prescription in general practice. Toronto: JB Lippincott, 1970.
- BARRETT JE, BARRETT JA, OXMAN TE, GERBER PD: The prevalence of psychiatric disorders in a primary care practice. Arch Gen Psychiatry 1988; 45, 1100-1119.
- BARSKY AJ: Hidden reasons some patients visit doctors. Ann Intern Medicine 1981; 94, 492-498.
- BECKMAN HB, FRANKEL RM: The effect of physician behavior on the collection of data. Ann Intern Medicine 1984; 101, 692-696.
- BELLANTUONO C, TANSELLA M (a cura di): Epidemiologia e Trattamento dei Disturbi Psichiatrici nella Medicina di Base. Quad Ital di Psichiatria (Numero Monografico) 1989; 8, 197-263.
- BENSING JM, DRONKERS J: Instrumental and affettive aspects of physician behaviour. Med Care 1992; 4, 283-298.
- BENSING JM, SLUJIS EM: Evaluation of an interview training course for general practitioners. Soc Sc Medicine 1985; 20, 737-744.
- BENSING JM: Implicit theories in research on doctor-patient communication. In: Bensing IM, Doctor-Patient Communication and the Quality of Care. Rotterdam/Uthecht: The Nederlands Istitute of Primary Health Care, 1991.
- BIRD J, HALL A, MAGUIRE P, HEAVY A: Workshops for consultants on the teaching of clinical communication skills. Med Education 1993; 27, 181-185.
- BLACKER CVR, CLARE AW: Depressive disorder in primary care. Br J Psychiatry 1987; 150, 737-751.
- BOWMAN FM, GOLDBERG DP, MILLAR T, GASK L, McGRATH G: Improving the skills of established general practitioners: the long-term benefits of group teaching. Med Education 1992; 26, 63-68.
- BURACK RC, CARPENTER RR: The predictive value of the presenting complaint. J Fam Practice 1983; 16, 749-754.
- BURNS BJ, SCOTT E, BURKE JD, KESSLER LG: Mental health training of primary care residents: a review of recent literature (1974- 1981). Gen Hosp Psychiatry 1983; 5, 157-169.
- BYRNE PS, HEATH CC: Pratictioners' use of non-verbal behaviour in real consultations. J Royal College Practitioners 1980; 30, 327-331.
- CALMAN KC, DONALDSON M: The pre-registration house officer year: a critical incident study. Med Education 1991; 25, 51-59.
- CARTER WB, INUI TS, KUKULL WA, HAIGH VH: Outcome-based doctor-patient interaction analysis. II. Identifing active provider and patient behaviour. Med Care 1982; 20, 550-566.
- COHEN-COLE S, FRIEDMAN C: The language problem: integration of psychosocial variables into medical care. Psychosomatics 1983; 24, 54-57.
- COHEN-COLE SA: The medical Interview. The Three Function Approach. Mosby Year Book, St. Louis, 1991.
- COX A, RUTTER M, HOLBROOK D: Psychiatric interviewing techniques V. Experimental study: eliciting factual information. Br J Psychiatry 1981; 139, 29-37.
- COX A, RUTTER M, HOLBROOK D: Psychiatric interviewing techniques. A second esperimental study: eliciting feelings. Br J Psychiatry 1988; 152, 64-72.
- DAVENPORT S, GOLDBERG D, MILLAR T: How psychiatric disorders are missed during medical consultations. Lancet 1987; ii, 439-441.
- DEPARTEMENT OF HEALTH AND SOCIAL SECURITY: On the state of the public health: the annual report of the chic medical. Officer of the Departement of Health and Social Security. London: HMSO, 1988.
- DOHERTY E, O'BOYLE CA, SHANNON W, McGEE H, BURY G: Communication skills training in undergraduate medicine. Irish Med Journal 1990; 83, 54-56.
- DUGGAN CF, LEE AS, MURRAY RM: Do different types of hospitalized depressives have different long-term outcomes? Arch Gen Psychiatry 1991; 48, 308-312.
- ENGEL GL: How much longer must medicine's science be bound by a seventeenth century world view? In: WHITE K (ed). The Task of Medicine. Menlo Park, CA: The Henry J Kaiser family Foundation, 1988.
- ENGEL GL: The clinical application of the biopsychosocial model. Am J Psychiatry 1980; 137, 535-544.
- ENGEL GL: The need for a new medical model: a challenge for biomedicine. Science 1977; 196, 129-136.
- ERAKER SA, KIRSCHT JP, BECKER MH: Understanding and improving patient compliance. Ann Intern Medicine 1984; 100, 258-268.
- FREELING P, TYLEE A: Depression in general practice. In: Handbook of Affective Disorders (ed. E.S. Paykel) (2nd edn). Edinburgh: Churchill Livingstone, 1992.
- FREELING P, RAO BM, PAYKEL ES, SIRELING LI, BURTON RH: Unrecognised depression in general practice. Br Med Journal 1985; 290, 1880-1883.
- FRITZPATRICK R, HOPKINS A: Problems in the conceptual framework of patient satisfaction research: an empirical exploration. Soc Health Illness 1983; 5, 297.
- GASK L, McGRATH G: Psychotherapy and general practice. Br J Psychiatry 1989; 154, 445-453.
- GASK L: Training general practitioners to detect and manage emotional disorders. Int Rev Psychiatry 1992; 4, 293-300.
- GASK L, BOARDMAN J, STANDART S: Teaching communication skills: a problem-based approach. Postgrad. Ed. Gen Practice 1991; 2, 7-15.
- GASK L, GOLDBERG DP, LESSER A, MILLAR T: Improving the psychiatric skills of the general practice trainee: an evaluation of a group training course. Med Education 1988; 22, 132-138.
- GASK L, McGRATH G, GOLDBERG D, MILLAR T: Improving the psychiatric skills of established general practitioners: evaluation of group teaching. Med Education 1987; 21, 362-368.
- GENERAL MEDICAL COUNCIL: Recommendations on Basic Medical Education. General Medical Council, London, 1980.
- GOLDBERG D, SMITH C, STEELE JJ, SPIVEY L: Training family doctors to recognise psychiatric illness with increased accuracy. Lancet 1980a; ii, 521-523.
- GOLDBERG D, STEELE JJ, SMITH C: Teaching psychiatric interview techniques to family doctors. Acta Psychiat Scand 1980b; 62, 41-47.
- GOLDBERG DP, BRIDGES K: Screening for psychiatric illness in general practice: the general pratictioner versus the screening questionnaire. J Royal College Gen Practitioners 1987; 37, 15-18.
- GOLDBERG DP, HUXLEY P: Common mental disorders: a biosocial model. London: Tavistock, 1992.
- GLODBERG DP, HUXLEY P: Mental Illness in the Community. The Pathway to Psychiatry Care. London: Tavistock, 1980.
- GOLDBERG DP, WILLIAMS P: A user's guide to the GHQ. London: NFER Nelson, 1988.
- GOLDBERG DP, JENKINS L, MILLAR T, FARAGHER EB: The ability of trainee general pratictioner to identify psychological distress among their patients. Psychol Medicine 1993; 23, 185-193.
- GOLDBERG DP, STEELE J, JOHNSON A, SMITH C: Ability of primary care physicians to make accurate ratings of psychological disturbance. Arch Gen Psychiatry 1982; 39, 829-833.
- GOOD MD, GOOD BJ, CLEARY PD: Do patient attitudes influence physician recognition of psychosocial problems in primary care? Fam Practice 1987; 25, 53-59.
- HALL JA, ROTER DL, KATZ NR: Task versus socioemotional behaviour. Med Care 1987; 25, 399.
- HALL JA, ROTER DL, KATZ NR: Meta-analysis of correlates of provider behaviour in medical encounters. Med Care 1988; 26, 657-675.
- HENNRIKUS D: An observational study of the detection of psychological disturbance by general practitioners. Ph D thesis, University of Newcastle, New South Wales, 1986.
- HOEPER E, NVEZ G, KESSLER L, BURKE J, PIERCE W: The usefulness of screening for mental illness. Lancet 1984; ii, 33-35.
- INUI TS, CARTER WB: Problems and prospects for health services research on provider-patient communication. Med Care 1985; 23, 251.
- JOHNSON J, WEISSMAN MM, KLERMAN GL: Service utilization and social morbidity associated with depressive symptoms in the community. JAMA 1992; 11, 1478-1483.
- JOHNSTONE A, GOLDBERG D: Psychiatric screening in general practice. Lancet 1976; i, 605-608.
- KASSIRER JP, KOPELMAN RI: Learning Clinical Reasoning. Baltimore, Md: Williams & Wilkins, 1991.
- KESSLER LG, CLEARY PD, BURKE JD: Psychiatric disorder in primary care. Arch Gen Psychiatry 1985; 42, 583-587.
- LESSER AL: Problem-based interviewing in general practice: a model. Med Education 1985; 19, 299-304.
- LESSER AL: The psychiatrist and family medicine: a different training approach. Med Education 1981; 15, 398-406.
- LEVENSTEIN JH, McCRACKEN EC, McWHINNEY IR, STEWART MA, BROWN JB: The patient-centred clinical method. 1. A model for the doctor-patient interaction in family medicine. Fam Practice 1986; 3, 24-30.
- MANN AH, JENKINS R, BELSE'Y E: The twelve-month outcome of patients with neurotic illness in general practice. Psychol Medicine 1981; 11, 535-550.
- MARKS J, GOLDBERG DP, HILLIER VF: Determinants of the ability of general pratictioners to detect psychiatric illness. Psychol Medicine 1979; 9, 337-353.
- MILLAR T, GOLDBERG DP: Link between tha ability to detect and manage emotional disorders: a study of general practitioner trainees. Br J Gen Practice 1991; 41, 357-359.
- MOORHEAD R: Communication skills training for general practice. Austral Fam Physician 1992; 21, 457-460.
- NORMAN GR, TUGWELL P: A comparison of resident performance on real and simulated patients. J Med Education 1982; 57, 703-715.
- ORMEL J, VAN DEN BRINK W, KOETER MWJ, GIEL R, VAN DEN MEER K, VAN DEN VILLIGE G, WILMINK FW: Recognition, management and outcome of psychological disorders in primary care: a naturalistic follow-up study. Psychol Medicine 1990; 20, 909-923.
- PLATT FW, McMATH JC: Clinical hypocompetence: the interview. Ann Intern Medicine 1979; 91, 898-902.
- RAND E, BADGER L, COGGINS D: Towards a resolution of contradictions: utility of feedback from the GHQ. Gen Hosp Psychiatry 1988; 10, 189-96.
- ROTER D, HALL J: Improving psychosocial problem address in primary care: it is possible and what difference does it make? Paper presented at the International Consensus Conference on Doctor-Patient Communication, Toronto, 1991.
- ROTER D: Which facets of communication have strong acts on outcome-a meta-analysis. In: Stewart M., Roter D., (eds). Communicating with medical patients. London: Sage Pubblications, 1989.
- ROTER DL, FRANKEL R: Quantitative and qualitative approaches to the evaluation of the medical dialogue. Soc Sc Medicine 1992; 10, 1097-1103.
- ROTER DL, HALL JA: Physicians' interviewing styles and medical information obtained from patients. J Gen Intern Medicine 1987; 2, 325-329.
- ROTER DL: Patient question asking in physician-patient interaction. Health Psychol 1984; 3, 395.
- ROTER DL, COLE KA, KERN DE, BARKER LR, GRAYSON M: An evaluation of residency training in interviewing skills and the psychosocial domain of medical practice. J Gen Intern Medicine 1990; 5, 347-354.
- ROTER DL, HALL JA, KATZ NR: Relations between physicians' behaviours and analogue patients' satisfaction, recall and impressions. Med Care 1987; 25, 437-451.
- ROTER LD, HALL JA, KATZ NR: Patient-physician communication: a summary the litterature. Patient Ed. descriptive of Couns 1988; 12, 99-119.
- SALTINI A, DALL'AGNOLA R: La comunicazione di cattive notizie. Indicazioni generali e linee guida. Rec Progr in Medicina 1995; 86, 409-417.
- SALTINI A: La comunicazione di cattive notizie. Informare o non informare il paziente: una scelta tra due alternative? Rec Progr in Medicina 1995; 86, 359-366.
- SANSON-FISHER RW, REDMAN S, WALSH R, MITCHELL K, REID ALA, PERKINS JJ: Training medical practitioners in information transfer skills: the new challenge. Med Education, 25, 322-333, 1991.
- SHAPIRO S, GERMAN P, SKINNER VON KORFF M, TURNER R, KLEIN L, TEITELBAUM M ET AL: An experiment to change detection and management of mental morbidity in primary care. Med Care 1987; 25, 327-39.
- SHEA JA, FRENKEL EP, WEBSTER GD: Training and practice activities of hematology and medical oncology diplomates. Arch Intern Medicine 1990; 150, 145-148.
- SIMPSON M, BUCKMAN R, STEWART M, MAGUIRE P, LIPKIN M, NOVACK D, TILL J: Doctor-patient communication: the Toronto consensus statement. Br Med Journal 1991; 303, 1385-1387.
- SKUSE D, WILLIAMS P: Screening for psychiatric disorder in general practice. Psychol Medicine 1984; 14, 365-377.
- SMITH RC, HOPPE RB: The patient's story: integrating the patient and physician-centered approaches to interviewing. Ann Intern Medicine 1991; 115, 470-477.
- SMITH RC, MARSHALL AA, COHEN-COLE SA: The efficacy of intensive biopsychosocial teaching programs for residents: a review of the literature and guidelines for teaching. J Gen Intern Medicine 1994; 9, 360-366.
- SPITZER RL, WILLIAMS JB, KROENKE K, LINZER M, DeGRUY FV, HAHN SR, BRODY D, JOHNSON JG: Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. JAMA 1994; 272, 1749-1756.
- STEWART M: Comparison of two methods of analyzing doctor-patient communication. Paper presented at the North America Primary Care Research Group. Seattle, 1985.
- STEWART MA: What is a successful doctor-patient interview? A study of interactions and outcomes. Soc Sc Medicine 1984; 2, 167-175.
- STOECKLE JD: Encounters Between Patients and Doctors: An Antology. Cambridge, MA: The MIT Press, 1987.
- STRAIN JJ, PINCUS HA, HOUPT JL, GISE LH, TAINTOR Z: Models of mental health training for primary care physicians. Psychosom Medicine 1985; 47, 95-110.
- SUCHMAN AL, MATTHEWS DA: What makes the patient-doctor relationship therapeutic? Exploring the connexional dimension of medical care. Ann Intern Medicine 1988; 108, 125-130.
- TANSELLA M, BELLANTUONO C: Provision of mental health care in general practice in Italy. Br J Gen Practice 1991; 41, 468-471.
- TANSELLA M, WILLIAMS P: The spectrum of psychiatric morbidity in a deed geographical area. Psychol Medicine 1989; 19, 765-770.
- TANSELLA M: Comunicazione personale, 1995.
- TYLEE P, FREELING P: The recognition, diagnosis and acknowledgement of depressive disorders by general practitioners. In: Depression: an Integrative Approach (ed. E. Paykel and K Herbst). pp. 216-231, London: Heinemann, 1989.
- USTUN TB, SARTORIUS N (Eds.): Mental Illness in General Health Care. An International Study. John Wiley & Sons. New York, 1995.
- VON KORFF M, ORMEL J, KATON W, LIN EH: Disability and depression among high utilizers of health care. A longitudinal analysis. Arch Gen Psychiatry 1992; 49, 91-100.
- VON KORFF M, SHAPIRO S, BURKE JD, TEITLEBAUM M, SKINNER EA, GERMAN P, TURNER RW, KLEIN L, BURNS B: Anxiety and depression in a primary care clinic: comparison of DIS, GHQ, and pratictioner assessments. Arch Gen Psychiatry 1987; 44, 152-156.
- VU NV, STEWARD DE, MARCY M: An assessment of the consistency and accuracy of standardized patients' simulations. J Med Education 1987; 62, 1000-1002.
- WHITE J, LEVINSON W, ROTER D: "Oh, by the way...": the closing moments of the medical visit. J Gen Intern Medicine 1994; 9, 24-28.
- WHITE K: The Task of Medicine. Menlo Park CA: The Henry J Kaiser Family Foundation, 1988.
- WHITEHOUSE C, MORRIS P, MARKS B: The role of actors in teaching communication. Med Education 1984; 18, 262-268.
- WILLIAMS P, SKUSE D: Depressive thoughts in general practice attenders. Psychol Medicine 1988; 18, 469-475.
- WILLIAMSON P, BEITMAN B, KATON W: Beliefs that foster physician avoidance of psychosocial aspects of health care. J Fam Practice 1981; 13, 999-1003.
- ZIMMERMANN Ch, TANSELLA M: Psychosocial factors andphysical illness in primary care. Promoting the biopsychosocial model in medical practice. J Psychosom Research 1 1996; 40 (4), 351-358.
- ZUNG WWK, MAGILL M, MOORE J, GEORGE DT: Recognition and treatment of depression in family practice. J Clin Psychiatry 1983; 44, 3-6.
TABELLA I
Comportamenti desiderabili durante l'intervista medica
- riconoscere e cogliere i segnali verbali di disagio emotivo (Mi sento giù di morale per...)
- rispondere ai segnali verbali di disagio emotivo con:
- domande aperte (Mi dica qualcosa di più a proposito di...)
- interventi di chiarificazione (Cosa intende con "sentirsi giù di morale"?)
- richiesta di esempi (Mi dica dell'ultima volta in cui si è sentito giù di morale)
- cogliere i segnali non verbali di disagio emotivo
- commentare e rispondere ai segnali non verbali di disagio emotivo (Mi sembra un po' inquieto...)
- rispondere con commenti empatici (Mi rendo conto che questo deve proprio essere un brutto periodo per lei)
- indagare le opinioni del paziente sulla propria salute
Adattato da: Gask et al., 1991
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